Open versus arthroscopic anterior latissimus dorsi transfer for irreparable subscapularis tear: a multicentre cohort study.

Abstract

Purpose: This study aimed to compare clinical outcomes between open and arthroscopic anterior latissimus dorsi (LD) transfer techniques for treating irreparable subscapularis (SSC) tears.

Methods: We retrospectively reviewed patients who underwent open or arthroscopic anterior LD transfer for irreparable SSC tears between February 2014 and August 2020. Patients were included if they had irreparable SSC tears with Lafosse Grade 4 or higher and Goutallier Grade 3 or higher, but without advanced arthritis (Hamada Grade < 3). Clinical assessments involved pain scores (visual analogue scale, VAS), patient-reported scores (Constant score and subjective shoulder value [SSV]), range of motion (ROM) and internal rotation (IR) strength. Any complications, integrity of the transferred tendon and progression of glenohumeral arthritis were evaluated. Patients were excluded from the study if they lacked follow-up data or were lost to follow-up.

Results: After excluding 28 patients, a total of 86 patients were included (34 arthroscopic and 52 open technique). The mean age was 63.5 ± 7.1 years, and the mean follow-up was 36.2 ± 14.9 months. Significant improvements were observed in pain (VAS from 7.2 ± 1.2 to 1.1 ± 1.5, p < 0.001), Constant score (from 29.1 ± 8.8 to 69.0 ± 12.6, p < 0.001) and SSV (from 24.3 ± 9.6 to 65.5 ± 15.7, p < 0.001). Shoulder ROM and IR strength also improved significantly. Both techniques showed comparable clinical outcomes, although the open technique group demonstrated greater gains in IR strength (p = 0.015). Complications included retear in 8.1% of patients and infection in 7%, with no significant differences between the two techniques.

Conclusion: Both open and arthroscopic anterior LD transfer techniques effectively reduce pain, improve shoulder function and enhance IR strength in patients with irreparable SSC tears, with comparable clinical outcomes and minimal complications.

Level of evidence: Level III, retrospective comparative case series.